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Deprecated: Implicit conversion from float 233.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 BMC+Pulm+Med 2020 ; 20 (1): 301 Nephropedia Template TP
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Broncho-alveolar inflammation in COVID-19 patients: a correlation with clinical outcome #MMPMID33198751
Pandolfi L; Fossali T; Frangipane V; Bozzini S; Morosini M; D'Amato M; Lettieri S; Urtis M; Di Toro A; Saracino L; Percivalle E; Tomaselli S; Cavagna L; Cova E; Mojoli F; Bergomi P; Ottolina D; Lilleri D; Corsico AG; Arbustini E; Colombo R; Meloni F
BMC Pulm Med 2020[Nov]; 20 (1): 301 PMID33198751show ga
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly reached pandemic proportions. Given that the main target of SARS-CoV-2 are lungs leading to severe pneumonia with hyperactivation of the inflammatory cascade, we conducted a prospective study to assess alveolar inflammatory status in patients with moderate to severe COVID-19. METHODS: Diagnostic bronchoalveolar lavage (BAL) was performed in 33 adult patients with SARS-CoV-2 infection by real-time PCR on nasopharyngeal swab admitted to the Intensive care unit (ICU) (n = 28) and to the Intermediate Medicine Ward (IMW) (n = 5). We analyze the differential cell count, ultrastructure of cells and Interleukin (IL)6, 8 and 10 levels. RESULTS: ICU patients showed a marked increase in neutrophils (1.24 x 10(5) ml(- 1), 0.85-2.07), lower lymphocyte (0.97 x 10(5) ml(- 1), 0.024-0.34) and macrophages fractions (0.43 x 10(5) ml(- 1), 0.34-1.62) compared to IMW patients (0.095 x 10(5) ml(- 1), 0.05-0.73; 0.47 x 10(5) ml(- 1), 0.28-1.01 and 2.14 x 10(5) ml(- 1), 1.17-3.01, respectively) (p < 0.01). Study of ICU patients BAL by electron transmission microscopy showed viral particles inside mononuclear cells confirmed by immunostaining with anti-viral capsid and spike antibodies. IL6 and IL8 were significantly higher in ICU patients than in IMW (IL6 p < 0.01, IL8 p < 0.0001), and also in patients who did not survive (IL6 p < 0.05, IL8 p = 0.05 vs. survivors). IL10 did not show a significant variation between groups. Dividing patients by treatment received, lower BAL concentrations of IL6 were found in patients treated with steroids as compared to those treated with tocilizumab (p < 0.1) or antivirals (p < 0.05). CONCLUSIONS: Alveolitis, associated with COVID-19, is mainly sustained by innate effectors which showed features of extensive activation. The burden of pro-inflammatory cytokines IL6 and IL8 in the broncho-alveolar environment is associated with clinical outcome.
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BMC+Pulm+Med 2020 ; 20 (1): 301
